Long-Term Resolution of Severe Ankle Contractures Using Botulinum Toxin, Serial Casting, Splinting, and Motor Retraining

Physiotherapy Canada. Physiothérapie Canada
Joan Leung, Katarina Stroud

Abstract

Purpose: Serial casting for ankle contractures is traditionally performed in prone, a position that patients may not easily tolerate. Also, although serial casting is effective in correcting contracture, its effect dissipates quickly. This case report describes a procedure for performing casting for ankle contractures in a supine or sitting position. It also describes a process that enables the effect of serial casting to be maintained long term. Client Description: The client was an adult who had suffered traumatic brain injury and severe bilateral ankle contractures. Intervention: He received botulinum toxin and serial casting for his bilateral ankle contractures, one ankle at 8 months and the other at 13 months after the injury. He then underwent a programme of splinting and motor training. Measures and Outcome: The client gained more than 40° dorsiflexion for both ankles after receiving botulinum toxin injections and serial casting. The improvement in ankle range enabled him to progress to walking practice. Ankle splinting was gradually reduced. On discharge at 25 months post-injury, the ankle joint range was maintained. Implications: The use of botulinum toxin and serial casting, followed by an intensive programme...Continue Reading

References

Dec 1, 1983·Physical Therapy·B J BoothJ Montgomery
Sep 18, 2004·Archives of Physical Medicine and Rehabilitation·Barbara J SingerJohn W Dunne
Oct 24, 2006·Pediatric Physical Therapy : the Official Publication of the Section on Pediatrics of the American Physical Therapy Association·Melissa Y BoothWilliam D Bandy
Apr 1, 1980·The Australian Journal of Physiotherapy·L Ada, D Scott
Jan 1, 1991·The Australian Journal of Physiotherapy·A Moseley, R Adams

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